Marijuana use increases, shifts away from illegal market
June 18, 2019
Science Daily/University of Washington
A new article published by researchers from University of Puget Sound and University of Washington reports that, based on analysis of public wastewater samples in at least one Western Washington population center, cannabis use both increased and substantially shifted from the illicit market since retail sales began in 2014.
Led by chemist Dan Burgard, the research team analyzed wastewater samples collected from 2013-2016 from two treatment plants that service a community of two hundred thousand in Western Washington.
"We set out to perform a wastewater-based analysis that explored the impact of newly legalized retail cannabis sales on its use, and to determine if this approach could estimate the size of the legal market place," says Burgard, who chairs the chemistry department at Puget Sound.
The researchers estimate that THC-COOH (the metabolite of psychoactive THC in cannabis created within the human body) found in wastewater has increased by 9% per quarter, on average, from December 2013 to December 2016. During this time, cannabis sales increased at nearly 70% per quarter, on average, for stores operating from August 2014 to December 2016.
"Given that wastewater represents a total population measure, these findings suggest that many established users switched very quickly from the illegal to the legal market," says Burgard. "This is the strongest statement possible regarding displacement of the illegal market."
Caleb Banta-Green, interim director and principal research scientist at University of Washington's Alcohol and Drug Abuse Institute, is a co-author of the article and was a key researcher on the project.
"This project was designed to aid the understanding of how the sales of adult recreational cannabis impact its total consumption within a population," says Banta-Green. "We believe this will be a valuable tool for local, state, national and international policy makers as they assess and consider Washington's recreational cannabis law."
In the past six years nine U.S. states (Colorado, Washington, Alaska, Oregon, Nevada, California, Maine, Massachusetts, Vermont, Michigan, and the District of Columbia), as well as the countries of Uruguay and recently Canada, have legalized the adult use of recreational cannabis.
"Existing measures, particularly surveys are subject to important biases and limitations, including potential changes in self-report as social norms change as well as very limited information on the amount of THC actually consumed," Banta-Green notes. "Wastewater based estimates help address these limitations."
The researchers note that their findings suggest that legalization is, in part, achieving one of its primary objectives which was to eliminate black market sales.
Funded in part by a grant from the National Institute on Drug Abuse, the research process included testing samples from 387 days spread over three years. The team utilized a new method that enables a complementary and potentially more timely and objective assessment of illicit drug consumption compared to existing measures.
Raw wastewater samples representing a full day are collected at a treatment plant and analyzed for drugs and their metabolites at extremely low concentrations (part per billion or part per trillion levels). These data can be used to track drug consumption trends, both legal and illegal, but not individual users. In some instances, the concentration of the metabolites can be used to "back calculate" to the actual number of doses of drug used in a particular area.
https://www.sciencedaily.com/releases/2019/06/190618174349.htm
Medical students not trained to prescribe medical marijuana
Many states allow medical pot, but few med schools address it
September 15, 2017
Science Daily/Washington University School of Medicine
More than half of the states in the US now allow some type of legal marijuana use, primarily medical marijuana. But, in a survey of medical residents and deans at the nation's medical schools, researchers have found that the majority of schools are not teaching their students about medical marijuana, and the majority of students don't feel prepared to discuss the subject with patients.
Although 29 states and the District of Columbia allow marijuana use for medical purposes, few medical students are being trained how to prescribe the drug. Researchers at Washington University School of Medicine in St. Louis surveyed medical school deans, residents and fellows, and examined a curriculum database maintained by the Association of American Medical Colleges (AAMC), learning that medical marijuana is not being addressed in medical education.
Their findings are available online in the journal Drug and Alcohol Dependence.
"Medical education needs to catch up to marijuana legislation," said senior author Laura Jean Bierut, MD, the Alumni Endowed Professor of Psychiatry at Washington University and a member of the National Advisory Council on Drug Abuse. "Physicians in training need to know the benefits and drawbacks associated with medical marijuana so they know when or if, and to whom, to prescribe the drug."
Doctors are being asked to guide patients through areas in which most have no training, she explained.
The research team, led by first author Anastasia B. Evanoff, sent surveys to medical school curriculum deans at 172 medical schools in North America, including 31 that specialize in osteopathic medicine, and received 101 replies. Two-thirds (66.7 percent) reported that their graduates were not prepared to prescribe medical marijuana. A quarter of deans said their trainees weren't even equipped to answer questions about medical marijuana.
The researchers also surveyed 258 residents and fellows who earned their medical degrees from schools around the country before coming to Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis to complete their training. Nearly 90 percent felt they weren't prepared to prescribe medical marijuana, and 85 percent said they had not received any education about medical marijuana during their time at medical schools or in residency programs throughout the country.
Using data from the AAMC database, the researchers found that only 9 percent of medical schools had reported teaching their students about medical marijuana.
"As a future physician, it worries me," said Evanoff, a third-year medical student. "We need to know how to answer questions about medical marijuana's risks and benefits, but there is a fundamental mismatch between state laws involving marijuana and the education physicians-in-training receive at medical schools throughout the country."
However, several states -- Missouri among them -- have not legalized medical marijuana, and published studies about potential risks and benefits of medical marijuana often are contradictory. So what are schools to teach?
"You address the controversy," said co-investigator Carolyn Dufault, PhD, assistant dean for education at Washington University and an instructor in medicine. "You say, 'This is what we know,' and you guide students to the points of controversy. You also point out where there may be research opportunities."
The authors argue that as more states legalize marijuana for medical and recreational use, doctors need to have at least enough training to answer patients' questions.
"More medical students are now getting better training about opioids, for example," said Evanoff. "We talk about how those drugs can affect every organ system in the body, and we learn how to discuss the risks and benefits with patients. But if a patient were to ask about medical marijuana, most medical students wouldn't know what to say."
https://www.sciencedaily.com/releases/2017/09/170915144132.htm